Healthcare Provider Details

I. General information

NPI: 1720781859
Provider Name (Legal Business Name): MICHAL BROOKE GILLIAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD
LEXINGTON KY
40503-1471
US

IV. Provider business mailing address

4524 PEBBLE BROOK CIR
LEXINGTON KY
40509-2151
US

V. Phone/Fax

Practice location:
  • Phone: 859-260-6100
  • Fax:
Mailing address:
  • Phone: 606-424-6282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number62145
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: